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Kidney disease, chronic

Introduction

Kidney disease, chronic

Chronic kidney disease (CKD) is a long-term condition where the kidneys don't work as well as they should. It's a common condition often associated with getting older. Anyone can get it, although it's more common in black people and people of south Asian origin. CKD can get gradually worse over time and eventually the kidneys may stop working altogether, but this is uncommon. Many people with kidney disease are able to live long, largely normal lives.

This section covers:

Symptoms of CKD

There are usually no symptoms of kidney disease in the early stages. It may only be picked up if blood or urine tests carried out for another reason detect a possible problem with your kidneys.

When it reaches a more advanced stage, symptoms can include:

See your GP if you have persistent or worrying symptoms that you think could be caused by kidney disease.

Read more about the symptoms of CKD.

Causes of CKD

Kidney disease is usually caused by other conditions that put a strain on the kidneys. Often it's the result of a combination of different problems.

CKD can be caused by:

You can help prevent CKD by making healthy lifestyle changes and ensuring any underlying conditions you have are well controlled.

Tests for CKD

CKD can be diagnosed using blood and urine tests. These tests are used to look for high levels of certain substances in your blood and urine that are signs your kidneys aren't working properly.

If you're at a high risk of developing kidney disease – for example, you have one of the conditions mentioned above – you may be advised to have regular tests to check for CKD so it's picked up at an early stage.

The results of your blood and urine tests can be used to tell the stage of your kidney disease. This is a number that reflects how severe the damage to your kidneys is, with a higher number indicating more serious CKD.

Read more about how CKD is diagnosed.

Treatments for CKD

There's no cure for CKD, but treatment can help relieve the symptoms and stop it getting worse.

Your treatment will depend on how severe your kidney disease is.

The main treatments are:

  • lifestyle changes to ensure you remain as healthy as possible
  • medication to control associated problems such as high blood pressure and high cholesterol
  • dialysis – treatment to replicate some of the kidney's functions; this may be necessary in advanced CKD
  • kidney transplant – this may also be necessary in advanced CKD

You'll also be advised to have regular check-ups to monitor your condition.

Read more about how CKD is treated and living with CKD.

Outlook for CKD

CKD can range from a mild condition with no or few symptoms, to a very serious condition where the kidneys stop working, sometimes called kidney failure.

Most people with CKD will be able to control their condition with medication and regular check-ups. CKD only progresses to kidney failure in around 1 in 50 people with the condition.

But if you have CKD, even if it's mild, you're at an increased risk of developing other serious problems, such as cardiovascular disease. This is a group of conditions affecting the heart and blood vessels, which includes heart attacks and strokes.

Cardiovascular disease is one of the main causes of death in people with kidney disease, although healthy lifestyle changes and medication can help reduce your risk of developing it.

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Symptoms

Many people with chronic kidney disease (CKD) won't have symptoms because it doesn't usually cause problems until it reaches an advanced stage.

Early stages of CKD

There don't tend to be any symptoms of kidney disease when it's at an early stage.

This is because the body is usually able to cope with a significant reduction in kidney function.

Kidney disease is often only diagnosed at this stage after a routine test, such as a blood or urine test, detects a possible problem.

If it's picked up at this stage, you may only need medication and regular tests to monitor it. This can help stop it becoming more advanced.

Later stages of CKD

A number of symptoms can develop if kidney disease isn't picked up early on or it gets worse despite treatment.

Symptoms can include:

This stage of CKD is known as kidney failure, end-stage renal disease or established renal failure. It may eventually require treatment with dialysis or a kidney transplant.

When to get medical advice

See your GP if you have persistent or worrying symptoms that you think could be caused by kidney disease.

The symptoms of kidney disease can be caused by many less serious conditions, so it's important to get a proper diagnosis.

If you do have CKD, it's best to get it diagnosed as soon as possible. Kidney disease can be diagnosed by having blood and urine tests.

Read more about how CKD is diagnosed.

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Diagnosis

Chronic kidney disease (CKD) can be diagnosed with blood and urine tests.

In many cases, it's only picked up because a routine blood or urine test indicates that the kidneys may not be working normally.

This page covers:

Who should be tested for CKD?

See your GP if you have persistent symptoms of CKD. They can look for other possible causes and arrange tests if necessary.

But as kidney disease often has no symptoms in the early stages, some people at a higher risk should ideally be tested regularly.

Regular testing is recommended for people with:

People taking long-term medications that can affect the kidneys, such as lithium, omeprazole or non-steroidal anti-inflammatory drugs (NSAIDs), should also be tested regularly.

Talk to your GP if you think you may need regular testing for kidney disease.

Tests for CKD

Blood test

The main test for kidney disease is a blood test that's used to work out how well your kidneys are working. The test measures the levels of a waste product called creatinine in your blood.

Using this result, a calculation that takes into account your age, gender and ethnic group is then done to work out how many millilitres of waste your kidneys are able to filter in a minute.

This measurement is known as your estimated glomerular filtration rate (eGFR).

Healthy kidneys should be able to filter more than 90ml/min. You may have kidney disease if your result is lower than this.

Read more about your test results below.

Urine tests

Urine tests are also usually carried out to:

  • check the levels of substances called albumin and creatinine in your urine – known as the albumin:creatinine ratio, or ACR
  • check for blood or protein in your urine

Alongside your eGFR measurement, these tests can help give a more accurate picture of how well your kidneys are working.

Read about test results, below, for more information.

Other tests

Sometimes other tests are also used to assess the level of damage to your kidneys.

These may include:

Test results and stages of CKD

Your test results can be used to determine how damaged your kidneys are, known as the stage of CKD.

This can help your doctor decide the best treatment for you and determine how often you should have tests to monitor your condition.

Your eGFR result is given as a stage from one to five:

  • stage 1 (G1) – a normal eGFR (above 90ml/min), but other tests have detected signs of kidney damage
  • stage 2 (G2) – a slightly reduced eGFR (60-89ml/min), with other signs of kidney damage
  • stage 3a (G3a) – an eGFR of 45-59ml/min
  • stage 3b (G3b) – an eGFR of 30-44ml/min
  • stage 4 (G4) – an eGFR of 15-29ml/min
  • stage 5 (G5) – an eGFR below 15ml/min, meaning the kidneys have lost almost all of their function

Your ACR result is given as a stage from one to three:

  • A1 – an ACR of less than 3mg/mmol
  • A2 – an ACR of 3-30mg/mmol
  • A3 – an ACR of more than 30mg/mmol

For both eGFR and ACR, a higher stage indicates more severe kidney disease.

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Treatment

There's no cure for chronic kidney disease (CKD), but treatment can help relieve the symptoms and stop it getting worse.

Your treatment will depend on the stage of your CKD.

The main treatments are:

  • lifestyle changes – to ensure you remain as healthy as possible
  • medication – to control associated problems, such as high blood pressure and high cholesterol
  • dialysis – treatment to replicate some of the kidney's functions, which may be necessary in advanced (stage 5) CKD
  • kidney transplant – this may also be necessary in advanced (stage 5) CKD

Read more about these treatments below.

Lifestyle changes

The following lifestyle measures are usually recommended for people with kidney disease:

Read about living with CKD for more information about what you can do to stay healthy.

Medication

There's no medicine specifically for CKD, but medication can help control many of the problems that cause the condition and complications that can occur as a result of it.

You may need to take medication to treat or prevent:

High blood pressure

Good control of blood pressure is vital to protect the kidneys.

People with kidney disease should usually aim to get their blood pressure down to below 140/90mmHg, but you should aim to get it down to below 130/80mmHg if you also have diabetes.

There are many types of blood pressure medication, but medicines called angiotensin converting enzyme (ACE) inhibitors are often used. Examples include ramipril, enalapril and lisinopril.

Side effects of ACE inhibitors can include:

If the side effects of ACE inhibitors are particularly troublesome, you can be given a medication called an angiotensin-II receptor blocker (ARB) instead.

Read more about how high blood pressure is treated.

High cholesterol

People with CKD have a higher risk of cardiovascular disease, including heart attacks and strokes.

This is because some of the causes of kidney disease are the same as those for cardiovascular disease, including high blood pressure and high cholesterol.

You may be prescribed medication called statins to reduce your risk of developing cardiovascular disease. Examples include atorvastatin, fluvastatin and simvastatin.

Side effects of statins can include:

Read more about how high cholesterol is treated.

Water retention

You may experience swelling in your ankles, feet and hands if you have kidney disease.

This is because your kidneys aren't as effective at removing fluid from your blood, causing it to build up in the body tissues (oedema).

You may be advised to reduce your daily salt and fluid intake, including fluids in food like soups and yoghurts, to help relieve the swelling.

In some cases you may also be given water tablets (diuretics) to take, such as furosemide.

Side effects of diuretics can include dehydration and reduced levels of sodium and potassium in the blood.

Anaemia

Many people with later-stage kidney disease develop anaemia, which is a lack of red blood cells.

Symptoms of anaemia include:

If you experience anaemia, you may be given injections of a medication called erythropoietin. This is a hormone that helps your body produce more red blood cells.

If you have an iron deficiency as well, iron supplements may also be recommended.

Read more about how iron deficiency anaemia is treated.

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Bone problems

If your kidneys are severely damaged, you can get a build-up of phosphate in your body because your kidneys cannot get rid of it.

Along with calcium, phosphate is important for maintaining healthy bones. But if your phosphate level rises too much, it can upset the balance of calcium in your body and lead to thinning of the bones.

You may be advised to limit the amount of high-phosphate food in your diet, such as red meat, dairy products, eggs and fish.

If this doesn't lower your phosphate level enough, you may be given medicines called phosphate binders. Commonly used medicines include calcium acetate and calcium carbonate.

Some people with kidney disease also have low levels of vitamin D, which is necessary for healthy bones, too.

If you're low in vitamin D, you may be given a supplement called colecalciferol or ergocalciferol to boost your vitamin D level.

Glomerulonephritis

Kidney disease can be caused by inflammation of the filters inside the kidneys, known as glomerulonephritis.

In some cases this occurs as a result of the immune system mistakenly attacking the kidneys.

If a kidney biopsy finds that this is the cause of your kidney problems, you may be prescribed medicine to reduce the activity of your immune system, such as steroid medication or a medication called cyclophosphamide.

Dialysis

In a small proportion of people with kidney disease, the condition will eventually get to a point where their kidneys stop working.

This rarely happens suddenly, so there should be time to plan the next stage of your treatment.

One of the options when CKD reaches this stage is to have dialysis. This is a procedure to remove waste products and excess fluid from the blood.

There are two main types of dialysis:

  • haemodialysis – this involves diverting blood into an external machine, where it's filtered before being returned to the body
  • peritoneal dialysis – this involves pumping dialysis fluid into the space inside your tummy to draw out waste products from the blood passing through vessels lining the inside of your tummy

Haemodialysis is usually done about three times a week, either at hospital or at home. Peritoneal dialysis is normally done at home several times a day, or overnight.

If you don't have a kidney transplant, treatment with dialysis will usually need to be lifelong.

Talk to your doctor about the pros and cons of each type of dialysis and discuss which type you would prefer if your kidney function becomes severely reduced.

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Kidney transplant

An alternative to dialysis for people with severely reduced kidney function is a kidney transplant.

This is often the most effective treatment for advanced kidney disease, but it involves major surgery and taking medications to stop your body attacking the donor organ (immunosuppressants) for the rest of your life.

You can live with one kidney, which means donor kidneys can come from recently deceased or living donors.

But there's still a shortage of donors, and sometimes you could wait months or years for a transplant.

You may need to have dialysis while you wait for a transplant.

Survival rates for kidney transplants are extremely good nowadays. About 90% of transplants still function after five years and many work usefully after 10 years or more.

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Supportive treatment

You'll be offered supportive treatment if you decide not to have dialysis or a transplant for kidney failure, or they're not suitable for you. This is also called palliative or conservative care.

The aim is to treat and control the symptoms of kidney failure. It includes medical, psychological and practical care for both the person with kidney failure and their family, including discussion about how you feel and planning for the end of life.

Many people choose supportive treatment because they:

  • are unlikely to benefit from or have a good quality of life with treatment
  • don't want to go through the inconvenience of treatment with dialysis
  • are advised against dialysis because they have other serious illnesses, and the negative aspects of treatment outweigh any likely benefits
  • have been on dialysis, but have decided to stop this treatment
  • are being treated with dialysis, but have another serious illness, such as severe heart disease or stroke, that will shorten their life

If you choose to have supportive treatment, your kidney unit will still look after you. Supportive care can still allow you to live for some time with a good quality of life.

Doctors and nurses will make sure you receive:

  • medicines to protect your remaining kidney function for as long as possible
  • medicines to treat other symptoms of kidney failure, such as feeling out of breath, anaemia, loss of appetite or itchy skin
  • help to plan your home and money affairs
  • bereavement support for your family

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Prevention

Chronic kidney disease (CKD) can't always be prevented, but you can take steps to reduce the chances of getting the condition.

Following the advice below can reduce your risk.

Manage underlying conditions

If you have a long-term condition that could potentially lead to kidney disease, such as diabetes or high blood pressure, it's important this is managed carefully.

Follow the advice of your GP, take any medication you're prescribed and keep all appointments relating to your condition.

Stop smoking

Smoking increases your risk of cardiovascular disease, including heart attacks or strokes, which is associated with a higher risk of kidney disease.

Stopping smoking will improve your general health and reduce your risk of these serious conditions.

If you want to give up smoking a good first step is to contact Stop Smoking Wales on 0800 085 2219. Visit the Stop Smoking wales website.

Read more about stopping smoking.

Healthy diet

balanced diet can reduce your risk of kidney disease by keeping your blood pressure and cholesterol at a healthy level.

A balanced diet should include:

  • plenty of fruit and vegetables – aim for at least five portions a day
  • meals based on starchy foods – such as potatoes, bread, rice or pasta
  • some dairy or dairy alternatives
  • some beans or pulses, fish, eggs, meat and other sources of protein
  • low levels of saturated fat, salt and sugar

You should also limit the amount of salt in your diet to no more than 6g (0.2oz) a day. Too much salt can increase your blood pressure.

Cut down on alcohol

Drinking excessive amounts of alcohol can cause your blood pressure and cholesterol levels to rise to unhealthy levels.

Sticking to the recommended alcohol limits is the best way to reduce your risk:

  • men and women are advised not to regularly drink more than 14 units a week
  • spread your drinking over three days or more if you drink as much as 14 units a week

Fourteen units is equivalent to six pints of average-strength beer or 10 small glasses of low-strength wine.

Read more about alcohol.

Exercise regularly

Regular exercise should help lower your blood pressure and reduce your risk of developing kidney disease.

At least 150 minutes (2 hours and 30 minutes) of moderate-intensity aerobic activity such as cycling or fast walking every week is recommended.

Read more about health and fitness.

Be careful with painkillers

Kidney disease can be caused by taking too many non-steroidal anti-inflammatories (NSAIDs), such as aspirin and ibuprofen, or taking them for longer than recommended.

If you need to take painkillers, make sure you follow the instructions that come with the medication.

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Living with

Most people can live a largely normal life with chronic kidney disease (CKD).

Although it's not possible to repair the damage that has already happened to your kidneys, your condition won't necessarily get worse.

Kidney disease only reaches an advanced stage in a small proportion of people.

But even if your condition is mild, it's important to take good care of yourself to help stop it getting worse and reduce your risk of other health problems, such as cardiovascular disease.

See below for advice about some of the main issues regarding living with kidney disease.

Looking after yourself:

Take your medication

It's very important that you take any prescribed medication, even if you don't feel unwell. Some medicines are designed to prevent serious problems occurring in the future.

It's also useful to read the information leaflet that comes with the medication about possible interactions with other medicines or supplements.

Check with your care team if you plan to take any over-the-counter remedies, such as painkillers or nutritional supplements. These can sometimes affect your kidneys or interfere with your medication.

Also speak to your care team if you have any concerns about the medication you are taking, or if you're experiencing any side effects.

Have a healthy diet

A healthy, balanced diet can help improve your general health and reduce your risk of developing further problems.

balanced diet should include:

  • plenty of fruit and vegetables – aim for at least five portions a day
  • meals based on starchy foods, such as potatoes, bread, rice or pasta
  • some dairy or dairy alternatives
  • some beans or pulses, fish, eggs, meat and other sources of protein
  • low levels of saturated fat, salt and sugar

You may also be given advice about dietary changes that can specifically help with kidney disease, such as limiting the amount of potassium or phosphate in your diet.

Exercise regularly

Regular physical activity can also help improve your general health.

Don't be scared to exercise. Exercise is good for anyone with kidney disease, however severe.

Not only will it boost your energy, help you sleep, strengthen your bones, ward off depression and keep you fit, it may also reduce your risk of problems such as heart disease.

If you have mild to moderate kidney disease, your ability to exercise shouldn't be reduced. You should be able to exercise as often and as vigorously as someone the same age as you with healthy kidneys.

If your condition is more advanced or you're already on dialysis, your ability to exercise is likely to be reduced, and you may become breathless and tired more quickly.

But don't be deterred – exercise is still beneficial. Make sure you start slowly and build up gradually. Check with your doctor before beginning a new exercise programme.

Stop smoking

If you smoke, stopping smoking can improve your overall health and reduce your risk of many other health problems. If you want to give up smoking a good first step is to contact Stop Smoking Wales on 0800 085 2219  or visit the Stop Smoking wales website.

Limit your alcohol consumption

You may still be able to drink alcohol if you have kidney disease, but it's advisable not to exceed the recommended limits of more than 14 alcohol units a week.

Speak to your GP or care team if you find it difficult to cut down the amount of alcohol you drink.

Read some tips on cutting down on alcohol.

Get vaccinated

Kidney disease can put a significant strain on your body and make you more vulnerable to infections.

Everyone with the condition is encouraged to have the annual flu jab and the one-off pneumococcal vaccination.

You can get these vaccinations at your GP surgery or a local pharmacy that offers a vaccination service.

Regular reviews and monitoring

You'll have regular contact with your care team to monitor your condition.

These appointments may involve:

  • talking about your symptoms – such as whether they're affecting your normal activities or are getting worse
  • a discussion about your medication – including whether you think you might be experiencing any side effects
  • tests to monitor your kidney function and general health

It's also a good opportunity to ask any questions you have or raise any other issues you'd like to discuss with your care team.

You may also want to help monitor your condition at home – for example, by using a home blood pressure monitor.

Contact your GP or care team if your symptoms are getting worse or you develop new symptoms.

Relationships and support:

Coming to terms with a condition such as kidney disease can put a strain on you, your family and your friends. It can be difficult to talk to people about your condition, even if they're close to you.

Learning about kidney disease often helps because you and your family will understand more about what to expect and feel more in control of the illness, instead of feeling that your lives are now dominated by kidney disease and its treatment.

Be open about how you feel, and let your family and friends know what they can do to help. However, do not feel shy about telling them that you need some time to yourself, if that is what you need.

Get support

Your GP or care team can reassure you if you have questions about your kidney disease, or you may find it helpful to talk to a trained counsellor, psychologist or specialist telephone helpline operator. Your GP surgery will have information on these.

Some people find it helpful to talk to other people with kidney disease at a local support group or through an internet chat room.

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Sex and pregnancy:

Sex

Having kidney disease can affect your sexual relationships. Some couples become closer after a diagnosis of kidney disease, while others find their loved ones are affected by worries about how they'll cope with the effects of the illness.

Both men and women may experience issues about body image and self-esteem, and this can affect the relationship.

Problems such as erectile dysfunction and reduced sex drive are also fairly common in people with kidney disease.

Try to share your feelings with your partner. If you have problems with sex that do not get better with time, speak to your care team. Treatment and support is available.

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Pregnancy

Both men and women with early stage kidney disease will find their fertility is unaffected. This means it is important to use contraception unless you want to have a baby.

Later stage kidney disease may affect women's periods, which can make pregnancy more difficult. For men, later stage kidney disease can cause a reduction in sperm count. However, having kidney disease does not mean you will not get pregnant or be able to father a child, so both men and women need to use an effective method of contraception unless they want to have a baby.

Women who want to have a baby should talk to their renal specialist or an obstetrician with an interest in kidney disease. Depending on the stage of kidney disease, there can be risks to both the mother and the baby. It is important to minimise any risk with a planned pregnancy. Your healthcare team can advise you about this.

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Money and finances:

Can I continue working?

If you're well enough, you can keep working for as long as you feel able.

Talk to your employer as soon as you feel your condition is affecting your ability to do your job so you can find a solution that suits both of you. For example, it may be possible for you to work part-time.

The Disability Discrimination Act 1995 requires employers to make reasonable adjustments to working practices or premises to help a person with a disability.

This might, where possible, include changing or modifying tasks, altering work patterns, installing special equipment, allowing time off to attend appointments, or helping with travel to work.

What happens if I can no longer work?

If you have to stop work or work part-time because of your kidney disease, you may find it hard to cope financially.

You may be entitled to one or more of the following types of financial support:

  • if you have a job but cannot work because of your illness, you are entitled to Statutory Sick Pay from your employer
  • if you don't have a job and cannot work because of your illness, you may be entitled to Employment and Support Allowance
  • if you're aged 65 or over, you may be able to get Attendance Allowance
  • if you're caring for someone with kidney disease, you may be entitled to Carer's Allowance 
  • you may be eligible for other benefits if you have children living at home or a low household income

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Holidays and insurance:

If you have mild kidney disease or you've had a transplant, going on holiday shouldn't pose additional health problems, whether you're staying in the UK or going abroad.

The British Kidney Patient Association can support people with kidney disease wanting to get away for a break.

Speak to your care team before you travel, and make sure you bring enough medication with you to cover your trip and some back-up medication in case you end up needing to stay away from home for longer than planned.

If you're on dialysis, you can still enjoy holidays provided you book your treatment before you go away.

If you want to travel to another part of the UK, discuss your plans with your renal unit as early as you can so they can arrange dialysis at a unit close to your destination.

In many parts of the country, the lack of facilities restricts the freedom of patients to travel, but Dialysis Freedom runs a holiday dialysis "swap" scheme to help with dialysis availability in other areas.

If you're going abroad, it can be easier to arrange dialysis at short notice as some overseas centres have more facilities, although holiday destinations may get booked up early.

The NHS will look after you if you get ill while on holiday in the UK. If you're in Europe, the European Health Insurance Card (EHIC) entitles you to free or reduced-cost hospital treatment.

It's a good idea to take out holiday health insurance in addition to carrying the EHIC. Anyone with kidney disease should declare it as a pre-existing medical condition on standard insurance application forms. It may exclude you from some policies.

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The information on this page has been adapted by NHS Wales from original content supplied by NHS Choices.
Last Updated: 12/09/2016 09:54:29

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